What does Medicare Plan K cover?
Medicare supplement Plan K is a Medigap policy. These policies help cover the gaps in Original Medicare parts A and B.
Private insurance companies sell Medigap policies, although not all policies are available in every state.
In this article, we describe Medicare Plan K, plan availability, benefits and restrictions, enrollment, and costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What is Medicare supplement Plan K?
This article originally appeared on Medical News Today
Medicare supplement Plan K is one of 10 Medigap policies. A person must have Original Medicare to buy a Medigap policy, and each policy covers a different set of standard benefits.
Medigap Plan K covers only one person. If a spouse wants Medigap Plan K, they must buy their own policy.
Where can I get Medicare Plan K?
Private insurance companies sell Medigap policies, but not all 10 Medigap policies are available in every state.
An insurance company decides which policies they offer, although federal laws govern that:
companies do not have to offer all 10 Medigap plans
a company must offer Medigap Plan A if they sell any Medigap plans
a company must also offer Plan C or F if they sell any Medigap plans
People can use Medicare’s Find a Medigap policy tool to get more information about the policies in their state. A person can also call the State Health Insurance Assistance Program (SHIP) or state insurance department.
What benefits are covered by Medicare Plan K?
Medicare standardizes the benefits that each Medigap policy offers, which means every Medicare Plan K will have the same standard benefits.
Some insurance companies may choose to offer more benefits, although the policy cost may increase as a result.
In general, most Medigap policies do not cover:
eye examinations for glasses
hearing tests
private duty nurses
The chart below shows which benefits have or do not have Medigap Plan K coverage.
Benefit | Does Plan K cover? |
Part A deductible | 50% |
Part A coinsurance and hospital costs | yes |
Part A coinsurance or copayment for hospice | 50% |
Part A coinsurance for skilled nursing facility care | 50% |
Part B deductible | no |
Part B coinsurance or copayment | 50% |
Part B excess charge | no |
blood, first 3 pints | 50% |
foreign travel exchange | no |
out-of-pocket limit | $7,060 in 2024 |
The following information provides more detail about the Part B deductible, out-of-pocket costs, and excess charges.
Part B deductible: Medigap plans C and F cover the Part B deductible. However, these plans are unavailable to people who turned 65 on or after January 1, 2020. People may be able to get these plans if they were eligible for Medicare before January 1, 2020, but did not enroll.
Out-of-pocket costs: After a person meets the yearly limit and Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.
Excess charge: This is the difference between what Medicare approves and what the doctor might charge.
What is not covered by Medicare Plan K?
Medigap Plan K restricts coverage for some benefits until a person meets the yearly out-of-pocket limit. Restricted coverage affects the following benefits:
Part A deductible to 50%
Part A coinsurance or copayment for hospice to 50%
Part A coinsurance for skilled nursing facility care to 50%
Part B coinsurance or copayment to 50%
first 3 pints of blood to 50%
In addition, Medigap Plan K policies do not cover either Part B excess charges or foreign travel.
When can I enroll in Plan K?
A person can buy Medicare Supplement Plan K during the 6-month Medigap Open Enrollment Period, which starts the month the person turns 65. To enroll in a Medigap plan, the person must have enrollment in Medicare Part B.
During this open enrollment, a person may buy Medigap Plan K even if they have health problems. They will be charged the same as people in good health.
After open enrollment, a person may not be able to buy a Medigap policy. This is because Medicare allows a company to use medical underwriting after the Open Enrollment Period. The process rates a person’s risk according to their health conditions, age, lifestyle choices, and other factors.
This process helps a company decide if they will cover a person and how much to charge. Therefore, if a company does decide to sell coverage, the premiums may be higher.
Enrollment limits
Guaranteed issue rights, also known as Medigap protection, means a company cannot deny someone a policy if their other health coverage changes.
For example, if someone’s Advantage plan leaves Medicare or stops coverage in their area, the individual may buy a Medigap policy with the same benefits as during the Open Enrollment Period.
What does Medicare Plan K cost?
Medigap Plan K monthly premiums are paid to the private company offering the plan. However, a person pays the premium for Original Medicare directly to Medicare.
Companies can decide on the premium amounts, although they are limited by three methods. The way the price is set affects how much people pay for as long as they have the policy. The limits are:
Attained-age-rated: The premium goes up as people get older.
Community-rated: All people pay the same premium no matter how old they are. However, premiums can change based on inflation or other factors.
Issue-age-rated: The price is based on a person’s age when they buy the policy. The premium cannot increase on the basis of age.
Other out-of-pocket expenses with Medigap policies may depend on factors determined by the company. For example, some offer discounts for people who have healthy habits or use electronic payment.
In addition, Medicare SELECT policies offer reduced premiums, but people must use in-network providers.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Summary
Medicare Plan K is a Medigap policy. It helps cover the gaps in Original Medicare coverage. This can include the Part A deductible, coinsurance, copayments, and blood.
In 2024, people with Medigap Plan K must pay a yearly out-of-pocket limit of $7,060. Once a person meets the limit, the policy pays 100% of the approved cost for the rest of the year.
Medicare Supplement Plan K does not cover foreign travel or the Part B excess charge. Most Medigap policies do not cover eye, dental, teeth, or long-term care.
Private insurance companies sell Medigap Plan K policies. They may cover more than standard benefits. The policies may cover the same benefits but can charge different premiums.
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View the original article on Medical News Today
